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Cardiovascular II > Valvular heart disease > Flashcards

Valvular heart disease Flashcards

1
Q

Incompetence of a valve stemming form an abnormality in one of its support structures, as opposed to a primary valve defect

A

Functional regurgitation

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2
Q

General secondary change from valvular stenosis

A

Pressure overload cardiac hypertrophy

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3
Q

General secondary change from mitral or aortic valvular insufficiency

A

Volume overload

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4
Q

Etiologies of abnormalities of leaflets and commissures leading to mitral regurgitation

A

Post-inflammatory scarring
Infective endocarditis
Mitral valve prolapse
Drugs (fen-phen)

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5
Q

Etiologies of abnormalities in tensor apparatus leading to mitral regurgitation

A

Rupture of papillary muscle
Papillary muscle dysfunction (fibrosis)
Rupture of chordae tendinae

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6
Q

Etiologies of abnormalities of LV and/or annulus leading to mitral regurgitation

A

LV enlargement –> myocarditis or dilated cardiomyopathy
Calcification of mitral ring

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7
Q

Etiology of mitral stenosis

A

Post inflammatory scarring –> rheumatic heart disease

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8
Q

Etiologies of aortic stenosis

A

Post inflammatory scarring –. rheumatic heart disease
Senile calcification
Calcification of congenitally deformed valve

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9
Q

Etiologies of aortic regurgitation

A

Post inflammatory scarring –> rheumatic heart disease
Degenerative aortic dilation
Syphilitic aortitis
Ankylosing spondylitis
RA
Marfan syndrome

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10
Q

Typical criteria for critical aortic stenosis

A

Area is <0.8 cm^2

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11
Q

Normal aortic valve area

A

3.5-4.0 cm^2

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12
Q

Age where symptoms typically present in congenital aortic stenosis

A

50 yr

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13
Q

Pathology of congenital aortic stenosis

A

Bicuspid valve

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14
Q

Foci of dystrophic calcification on aortic valves

A

Degenerative aortic stenosis

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15
Q

Consequences over time in aortic stenosis

A

Reduced compliance of LV
Significant increased in LVEDP
Hypertrophy of LA

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16
Q

Change in diastolic PV curve in aortic stenosis

A

Moves upward

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17
Q

Change in isovolumic pressure curve in aortic stenosis

A

Upward and leftward

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18
Q

Reason for angina in aortic stenosis

A

Increased myocardial oxygen demand and reduced oxygen supply

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19
Q

Symptoms that may occur in aortic stenosis

A

Angina
Syncope on exertion
HF

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20
Q

Reason for exertional syncope in aortic stenosis

A

Peripheral vasodilation and inability to augment CO results in decreased cerebral perfusion pressure

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21
Q

Changes in carotid pulse in aortic stenosis

A

Weakened/parvus and delated/tardus upstroke

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22
Q

Reason for carotid pulse changes in aortic stenosis

A

Fixed, obstructed LV flow

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23
Q

Murmur of aortic stenosis

A

Crescendo-decrescendo systolic ejection murmur heard best at base that often radiates to neck and apex

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24
Q

Reason for S4 heart sounds in aortic stenosis

A

Due to atrial contraction into the stiff LV

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25
Q

Compensation of aortic regurgitation

A

Eccentric hypertrophy

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26
Q

Combination of high LV SV and high systolic arterial pressure with a reduced aortic diastolic pressure. Widened pulse pressure.

A

Aortic regurgitation

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27
Q

Symptoms of acute aortic regurgitation

A

Dyspnea and pulmonary edema

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28
Q

Change in PV loop in aortic regurgitation

A

Diastolic PV curve shifts right
Isovolumic PV curve shifts left at first, then right
Very large SV

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29
Q

Change in pulse in aortic regurgitation

A

Hyperdynamic pulses due to widened pulse pressures

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30
Q

Types of hyperdynamic pulses

A

Water hammer/Corrigan
Quincke
DeMusset sign
Muller sign

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31
Q

DeMusset sign

A

Head-bobbing from widened pulse pressure

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32
Q

Muller sign

A

Rhythmic pulsation of the uvula due to widened pulse pressure

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33
Q

Quincke pulse

A

Arterial pulsation seen in nail bed

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34
Q

Water hammer or Corrigan pulse

A

Sudden rise then drop in pressure

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35
Q

High-pitched, blowing, early diastolic murmur heard best along the L sternal border.

A

Aortic regurgitation

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36
Q

Normal mitral valve area

A

5-6 cm^2

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37
Q

Mitral valve area when hemodynamic changes become apparent

A

<2 cm^2

38
Q

Cause of dyspnea in mitral stensois

A

Transudation of plasma into lung interstitium and alveoli because of increased pressure

39
Q

Cause of hemoptysis in mitral stenosis

A

Collateral between bronchial and pulmonary veins leading to engorgement and rupture of bronchial V

40
Q

Complication of chronic pressure overload in LA in mitral stenosis

A

A fib –> intra-mural thombus

41
Q

PV loop changes in mitral stenosis

A

Decreased SV
Overall slight shift left

42
Q

Symptom of mild mitral stenosis

A

Dyspnea on exertion

43
Q

Symptoms of severe mitral stenosis

A

Dyspnea at rest
Increasing fatigue
Orthopnea
PND

44
Q

Cause of hoarseness of voice related to mitral stenosis

A

Enlarged pulmonary A or LA compresses the recurrent laryngeal N

45
Q

Ortner syndrome

A

Hoarseness due to compression of recurrent laryngeal N from enlarged cardiovascular structures

46
Q

High pitches opening snap after S2. Followed by a low-frequency decrescendo diastolic murmur

A

Mitral stenosis

47
Q

Best indicator of mitral stenosis severity on auscultation

A

A2-OS interval shortens as LA pressure increases

48
Q

Antibodies in rheumatic fever

A

To streptolysin O and DNase B

49
Q

JONES criteria of rheumatic fever

A

Joint pain –> migratory polyarthritis
Carditis
Nodules in skin, subcutaneous
Erythema marginatum
Sydenham’s chorea

50
Q

Hypersensitivity in transient migratory polyarthritis in rheumatic fever

A

Type II hypersensitivity –> results from formation of immune complexes

51
Q

Cross-reaction of antibodies in rheumatic fever

A

To group A carbohydrate or streptococcal M protein

52
Q

Affect of IgG antibodies on valve endothelium in rheumatic fever

A

Upregulate vascular cell adhesion 1 (VCAM1) and promote infiltration of T cells

53
Q

Aschoff nodule formation in acute rheumatic fever

A

Result of intense inflammatory process, mainly mediated by CD4 cells. Form on valves

54
Q

Pathological consequences of inflammation from acute rheumatic fever on the heart

A

Dilation of valve annuli
Elongation of chordae tendinae

55
Q

Rings that surround heart valve that help close leaflets during systole

A

Valve annuli

56
Q

Foci of T cells, occasional plasma cells, and plump activated macrophages seen microscopically in acute rheumatic fever

A

Aschoff bodies

57
Q

Anitschkow cells

A

Plump activated macrophages

58
Q

Anatomic changes of the mitral valve in rheumatic heart disease

A

Leaflet thickening
Commissural fusion and shortening
Thickening and fusion of tendinous cords

Results in stenosis

59
Q

Compensation in mitral regurgitation

A

LA and LV dilation and hypertrophy

60
Q

PV loop changes in mitral regurgitation

A

Diastolic shifts rightward
Significantly increased SV
Isovolemic eventually shifts R

61
Q

Cardiac marker changes in acute mitral regurgitation

A

Significantly increased preload
Decreased afterload
No change in contractile function
Significantly increased EF
Decreased forward SV

62
Q

Cardiac marker changes in compensated chronic mitral regurgitation

A

Increased preload
No change in afterload, contractility, or forward SV
Increased EF

63
Q

Cardiac marker changes in decompensated mitral regurgitation

A

Increased preload and afterload
Decreased contractility, EF, and forward SV

64
Q

Best indicator of mitral regurgitation severity

A

Audible S3

65
Q

Irregular, stony, hard, and occasionally ulcerated nodules at the base of the mitral valve leaflets

A

Mitral annular calcification

66
Q

Possible complication of mitral annular calcification

A

Embolic stroke
Infective endocarditis

67
Q

Mitral valve disorder associated with heritable CT disorders and excess TGF-beta activity

A

Mitral valve prolapse

68
Q

Mid-systolic click that may be followed by a mid to late systolic murmur best heard at apex

A

Mitral valve prolapse

69
Q

Rare serious complications of mitral valve prolapse

A

Infective endocarditis
Mitral insufficiency, possibly with chordal rupture
Stroke or other systemic infarct
Arrhythmias

70
Q
A
71
Q

Affected mitral leaflets are often enlarged, redundant, thick, and rubbery. Tendinous cords may be elongated, thinned, or ruptured, Annulus may be dilated.

A

Mitral valve prolapse

72
Q

Microscopy of mitral valve shows marked thickening of the spongiosa layer with deposition of mucoid/myxomatous material. Attenuation of collagenous fibrosa layer of the valve.

A

Mitral valve prolapse

73
Q

Stain that makes collagen yellow, elastin black, and proteoglycans blue.

A

Movat pentachrome stain

74
Q

Microbial infection of the heart valves or mural endocardium leading to formation of vegetations composed of thrombotic debris and organisms.

A

Infective endocarditis

75
Q

Modified duke criteria of infective endocarditis

A

Fever
Roth spots
Osler nodes
Murmur
Janeway lesions
Anemia
Nail bed splinter hemorrhages
Emboli

76
Q

White-centered retinal hemorrhages

A

Roth spots

77
Q

Painful, red, raised lesions on the hands and feet. Associated with infective endocarditis.

A

Osler nodes

78
Q

Irregular, nontender, hemorrhagic macules located on the palms and soles. Associated with infective endocarditis

A

Janeway lesions

79
Q

Complications of infective endocarditis

A

Glomerulonephritis
Septic arterial or pulmonary emboli

80
Q

Friable, bulky, potentially destructive lesions containing fibrin, inflammatory cells, and infectious organism that form vegetations on heart valves.

A

Infective endocarditis

81
Q

Form when infectious vegetations erode into the underlying myocardium and produce an abscess in infective endocarditis

A

Ring abscess

82
Q

Deposition of small, bland, sterile thrombi on the leaflets of cardiac valves. Non-invasive and do not elicit inflammatory reaction.

A

Nonbacterial thrombotic endocarditis

83
Q

Marantic endocarditis

A

Nonbacterial thrombotic endocarditis in pts with cancer or sepsis

84
Q

Conditions associated with nonbacterial thrombotic endocarditis

A

DVT
PE
Hypercoagulable states
Endocardial trauma

85
Q

Condition associated with Libman-Sacks endocarditis

A

SLE

86
Q

Pink, sterile vegetations on undersurface of AV valves with a warty/verrucous appearance

A

Libman-Sacks endocarditis

87
Q

Complication of Libman-Sacks endocarditis

A

Mitral and tricuspid valvulitis

88
Q

Complications of transcatheter aortic valve replacement (TAVR)

A

Paravalvular lead
Stroke
MI

89
Q

Reason for MI post TAVR

A

Obstruction of coronary A ostia by implanted valve

90
Q

Reason for paravalvular leak in TAVR

A

Inappropriate size or position of valve
Improper sealing to native annulus
Blood leakage around valve
Aortic regurgitation

Cardiovascular II (29 decks)

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